The use of fecal calprotectin and lactoferrin in patients with IBD. Review.

Endoscopy has been the gold standard for diagnosing and following patients with inflammatory bowel disease. However, ileocolonoscopy is still an expensive and invasive method. Secondly we do know that clinical scores for ulcerative colitis and Crohn's disease are subjective which creates several problems. And thirdly, when using the known serological markers such as C-reactive protein, white blood cell count en albumin, one should take into account that these markers are not perfect or superior to the current diagnostic techniques given their low sensitivity and specificity. Fecal markers may prove to have a greater specificity. Calprotectin can differentiate between active and inactive inflammatory bowel disease and between inflammatory bowel disease and irritable bowel syndrome. It correlates with the severity of symptoms and it may predict relapse especially in ulcerative colitis. Finally it can be used as a surrogate marker for the endoscopic response during treatment given a normal value of calprotectin is a reliable marker for mucosal healing. Lactoferrin also seems to be a sensitive and specific marker for the detection of chronic inflammation and for predicting relapse. The relationship with the endoscopic activity is significant and lactoferrin values are significantly higher in active endoscopic disease as compared to inactive disease. Finally, given the significant correlation with endoscopic activity, lactoferrin can function as an adequate marker for the monitoring of therapy.